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Nasal incisions are useful for uncommon surgery, study shows
These incisions may be used for surgery in an eye with against-the-rule astigmatism without affecting corneal shape, such as with temporal incisions.
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VIENNA, Austria — Using nasal incisions to reduce astigmatism, as well as provide additional comfort for both surgeons and patients in phacoemulsification, showed astigmatism of 0.8 D after 1 postoperative day. This was reduced to 0.67 D after the first postoperative month and remained stable after 6 months, according to Simonetta Morselli, MD.
Astigmatism, she continued, was measured postoperatively by autokeratometry and corneal topography on the first postoperative day and on the first and sixth month after surgery.
In her presentation at the European Society of Cataract and Refractive Surgeons meeting here, Dr. Morselli explained that she began using nasal incision for against-the-rule astigmatism (where the steep axis is within 30° of the horizontal, an infrequent occurrence) for phacoemulsification surgery in the left eye “because we cannot switch around the side of the bed for temporal incisions and re-evaluate how comfortable this incision is and how much astigmatism is induced,” she said.
Study of 34 eyes
---Dr. Morselli pointed out that with nasal incisions, induced astigmatism after 6 months was similar to that reported by other investigators.
Dr. Morselli’s study involved 34 left eyes, which she operated on, after applying topical anesthesia. Co-author of the study was Nicola Canali, MD. The phacoemulsification surgery used clear corneal nasal incisions, intraocular anesthesia and chopping.
Other indications of patients who might benefit from the Morselli approach include those with against-the-rule astigmatism, “especially 130° to 170° axis,” she said.
The nasal incision technique she used “was not uncomfortable. We also found that topical anesthesia was mandatory and, in fact, the patient can look at the microscope if we turn to the right,” Dr. Morselli continued. In addition, the incisions were enlarged to 4 mm to implant foldable lenses.
Using corneal maps to illustrate her presentation, Dr. Morselli pointed out that with nasal incisions, induced astigmatism after 6 months was similar to that reported by other investigators.
Dr. Morselli also noted that “if the surgeon is limited with a surgical position, and stays at the head of the bed, it seems safer for him or her to use the right hand if he or she is right-handed for left eye surgery.
“During binocular, simultaneous phacoemulsification, a nasal incision may be used for surgery in the left eye with against-the-rule astigmatism without affecting corneal shape such as with the temporal incision,” she said.
For Your Information:
- Simonetta Morselli, MD, can be reached at Via Manzoni 15, Verona 37100, Italy; telephone and fax: (39) 045-8103746; e-mail: s.morselli@intesys.it. Dr. Morselli has no direct financial interest in any of the products mentioned in this article, nor is she a paid financial consultant for any companies mentioned.